Cardiac and Antihypertensive Meds Flashcards
1
Q
High Ceiling Loop Diuretics prototype
A
Furosemide
2
Q
High Ceiling Loop Diuretics action
A
works in the ascending limb of loop of henle, blocks reabsorption of sodium and chloride and prevents reabsorption of water, causes extensive diuresis even with severe renal impairment.
3
Q
High Ceiling Loop Diuretics therapeutic use
A
used when emergent need for rapid mobilization of fluid, pulmonary edema caused by heart failure, conditions not responsive to other diuretics, cush as edema caused by liver, cardiac, or kidney disease, or hypertension, unlabeled use hypercalcemia
4
Q
High Ceiling Loop Diuretics complications
A
DEHYDRATION, HYPONATREMIA, HYPOCHLOREMIA (assess/ monitor for dehydration, monitor electrolytes, report decreased urine output - stop medication and notify provider, notify pain indicative of thrombus or embolus, minimize risk for dehydration)
HYPOTENSION (monitor BP, monitor for effects of postural hypotension and lay down if symptoms occur, avoid sudden changes of position)
OTOTOXICITY transient with Furosemide (notify provider of symptoms, avoid use with other ototoxic medication such as aminoglycoside antibiotics)
HYPOKALEMIA less than 3.5 (monitor cardiac status and potassium levels, report decrease in potassium, teach clients to consume high potassium foods, teach manifestations of hypokalemia - N/V, fatigue, leg cramps, general weakness)
HYPERGLYCEMIA, HYPERURICEMIA, HYPOCALCEMIA, HYPOMAGNESEMIA, DECREASE IN HDL, INCREASE IN LDL (monitor blood glucose, uric acid, calcium, magnesium, and lipid levels, report levels outside of reference range, observe for manifestations of low magnesium levels)
5
Q
High Ceiling Loop Diuretics contraindications/ precautions
A
do not use in pregnancy, contraindicated with anuria, cautious in clients with cardiovascular disease, diabetes mellitus, dehydration, electrolyte depletion, and gout. Also cautious in pts taking digoxin, lithium, ototoxic meds, NSAIDs, or antihypertensives. digoxin toxicity can occur in presence of hypokalemia, concurrent use of antihypertensives can have additive hypotensive effects, lithium carbonate serum levels can increase, NSAIDs decrease blood flow to kidneys which reduces diuretic effect
6
Q
High Ceiling Loop Diuretics nursing administration
A
weigh pt same time each day, monitor BP and I&O, do not dose at night, monitor K, monitor orthostatic bp, electrolytes and edema
7
Q
Thiazide Diuretics prototype
A
Hydrochlorothiazide
8
Q
Thiazide Diuretics action
A
work in early distal convoluted tubule, blocks reabsorption of sodium and chloride and prevents reabsorption of water at this site, promotes diuresis when renal function is not impaired
9
Q
Thiazide Diuretics therapeutic use
A
1st choice for essential hypertension, used for edema of mild to mod heart failure and liver and kidney disease, used in combination with antihypertensive agents for BP control, to reduce urine production in diabetes insipidus, promote reabsorption of Ca and can reduce risk for postmenopausal osteoporosis
10
Q
Thiazide Diuretics complications
A
DEHYDRATION and HYPONATREMIA (assess/ monitor for dehydration, monitor electrolytes and weight, report decreased urine output- stop med and notify provider)
HYPOKALEMIA and HYPOCHLOREMIA (monitor potassium and cardiac status especially if taking digoxin, report potassium below 3.5, consume foods high in potassium, recognize signs of hypokalemia- N/V, general weakness, fatigue, leg cramps)
HYPERGLYCEMIA
HYPERURICEMIA, HYPOMAGNESEMIA, INCREASED LDL (monitor uric acid, magnesium, LDL, HDL, monitor for signs of low magnesium- weakness, muscle twitching, tremors)
11
Q
Thiazide Diuretics contraindications/ precautions
A
avoid during pregnancy and lactation, contraindicated with renal impairment, caution in cardiovascular disease, diabetes mellitus, hypokalemia, hyperlipidemia, hypomagnesemia, and gout, caution with digoxin, lithium, or antihypertensives
12
Q
Thiazide Diuretics nursing administration
A
baseline data, monitor K levels, take in morning, eat foods high in K, take with or after meals, alternate-day dosing can decrease electrolyte imbalance, weight each day, get up slowly, teach pts to self-monitor and report weight loss, lightheadedness, dizziness, GI distress, weakness, monitor blood glucose levels
13
Q
Potassium- Sparing Diuretics prototype
A
Spironolactone
14
Q
Potassium- Sparing Diuretics action
A
block the action of aldosterone (Na and H2O retention) which results in K+ retention and excretion of sodium and water
15
Q
Potassium- Sparing Diuretics therapeutic use
A
treat hypertension and edema when combined with other diuretics, administered for heart failure, block aldosterone in primary hyperaldosteronism by retaining K+ and increasing Na+ excretion, causing and opposite effect of the action of aldosterone in the distal nephrons, therapeutic effects can take 12 to 48 hours
16
Q
Potassium- Sparing Diuretics complications
A
HYPERKALEMIA (monitor potassium levels and place cardiac monitor with level greater than 5, monitor electrolytes for manifestations of hyperkalemia such as weakness, fatigue, dyspnea, or dysrhythmias, treat hyperkalemia and stop med, do not administer other potassium sparing supplements, caution with ACE inhibitors, ARBs, and direct renin inhibitors because they can elevate potassium)
DEEPENED VOICE and IMPOTENCE in male clients and IRREGULAR MENSTRUAL CYCLE in females
DROWSINESS, METABOLIC ACIDOSIS (avoid activities that require alertness, monitor for metabolic acidosis such as drowsiness and restlessness
17
Q
Potassium- Sparing Diuretics contraindications/ precautions
A
do not give to patients with hyperkalemia, are taking potassium supplements, or taking another potassium sparing diuretics, do not give to pts with severe kidney failure and anuria, caution if kidney or liver disease, electrolyte imbalances, or metabolic acidosis
18
Q
Potassium- Sparing Diuretics nursing administration
A
baseline data, weight clients, monitor BP and I&O, monitor ECG and K+ levels, avoid salt substitutes, teach self-monitor BP, instruct to keep log BP and weight, pt report cramps, diarrhea, thirst, altered menstruation, or deepened voice, avoid activities that require alertness
19
Q
Osmotic Diuretics prototype
A
Mannitol
20
Q
Osmotic Diuretics action
A
reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing fluid back into the vascular and extravascular space
21
Q
Osmotic Diuretics therapeutic use
A
prevents kidney failure when there is hypovolemic shock and severe hypotension (because mannitol is not reabsorbed and remains in the nephron preventing urine flow and kidney failure), decreases intracranial pressure caused by cerebral edema, decreases intraocular pressure by drawing ocular fluid into the bloodstream, promotes sodium retention and water excretion in clients who have hyponatremia and fluid volume excess, administered for the oliguria phase of acute kidney injury
22
Q
Osmotic Diuretics complications
A
HEART FAILURE and PULMONARY EDEMA (stop med immediately and notify provider)
REBOUND INCREASED INTRACRANIAL PRESSURE (monitor for change in level of consciousness, change in pupils, HA, nausea, and vomiting)
FLUID AND ELECTROLYTE IMBALANCES, METABOLIC ACIDOSIS (monitor for drowsiness and restlessness)
23
Q
Osmotic Diuretics contraindications/ precautions
A
active intracranial bleed, anuria, severe pulmonary edema, severe dehydration, renal failure, use caution in patients who have heart failure, are pregnant or breastfeeding, renal insufficiency and electrolyte imbalances
24
Q
Osmotic Diuretics nursing administration
A
administer by IV infusion, monitor daily weight, I & O, serum electrolytes, monitor for dehydration and increased edema, obtain baseline on orthostatic hypotension, monitor BP, if potassium goes below 3.5 monitor ECG, monitor for metabolic acidosis such as drowsiness and restlessness
25
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL prototype
Captopril
26
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL action
reduce production of angiotensin 2 by blocking the conversion of angiotensin 1 and 2 and increasing levels of bradykinin leading to vasodilation(areteriole), excretion of sodium and water , retention of potassium by actions in the kidneys, reduction of patho changes in blood vessels and heart that result from presence of angiotensin 2 and aldosterone
27
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL therapeutic use
hypertension, heart failure, MI, diabetic and nondiabetic nephropathy
28
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL complications
FIRST DOSE ORTHOSTATIC HYPOTENSION (stop diuretic 2-3 days before first dose, hypotensive effects more significant when also taking other antihypertensive, start treatment with low dose, monitor BP for two hours after dose, change positions slowly)
COUGH related to inhibition of kinase 2 (ACE) which results in increase in bradykinin (report symptoms to provider)
HYPERKAEMIA
RASH and DYSGEUSIA- altered taste (alert provider, symptoms will stop with discontinuation of med)
ANGIOEDEMA- swelling of tongue and oral pharynx (treated with injection of subcutaneous epinephrine, discontinue med)
NEUTROPENIA- rare but serious (monitor WBC every two weeks for three months and then periodically, reversible when detected early, notify provider of first signs of infection)
29
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL contraindications/ precautions
pregnancy risk category D in 2nd and 3rd tri, not for patients with single kidney or have collagen vascular disease (greater risk for developing neutropenia), contraindicated in clients who have history of allergy/ angioedema to ACE inhibitor, or those with bilateral renal artery stenosis
30
Angiotensin Converting Enzyme Inhibitors (ACE) PRIL nursing administration
administer orally except enalaprilat which is IV, advise it may be used in combination with thiazide diuretic, monitor BP after 1st dose for at least 2 hours for hypotension, take 1 hour before meals, notify provider if dry cough, rash or altered taste occur, no sudden change of position, avoid activities that require alertness
31
Angiotensin II Receptor Blockers (ARBs) ARTAN prototype
Losartan
32
Angiotensin II Receptor Blockers (ARBs) ARTAN action
block the action of angiotensin 2 in the body, results in vasodilation of arterioles and veins, excretion of sodium and water by decreasing the release of aldosterone
33
Angiotensin II Receptor Blockers (ARBs) ARTAN therapeutic use
hypertension, stroke prevention, delay progression of diabetic nephropathy and diabetic retinopathy
34
Angiotensin II Receptor Blockers (ARBs) ARTAN complications
*cough and hyperkalemia are not adverse effects
ANGIOEDEMA (discontinue and treat with SQ injection of epinephrine)
FETAL INJURY
HYPOTENSION (monitor BP, carefully change positions)
DIZZINESS and LIGHTHEADEDNESS (avoid activities that require alertness)
35
Angiotensin II Receptor Blockers (ARBs) ARTAN contraindications/ precautions
pregnancy risk category D, ARBS cause fetal damage in 2nd and 3rd trimester, contraindicated with renal stenosis or one kidney, use cautiously in patients who experienced angioedema with ACE inhibitor
36
Angiotensin II Receptor Blockers (ARBs) ARTAN nursing administration
administer orally, take with or without food, monitor weight and edema
37
Calcium Channel Blockers prototype
Diltiazem and Verapamil
38
Calcium Channel Blockers action
blocks the calcium channels in blood vessels leads to vasodilation of arterioles in heart and peripheral arterioles of the heart, blocking of the calcium channels in the myocardium SA node and AV node decreases the force of the contraction, decreases the heart rate and slows the rate of conduction through the AV node, act on arterioles and the heart at therapeutic doses, veins are not significantly effected
39
Calcium Channel Blockers therapeutic use
angina pectoris, hypertension, cardiac dysrhythmias (a-fib, a-flutter and SVT)
40
Calcium Channel Blockers complications
ORTHOSTATIC HYPOTENSION and PERIPHERAL EDEMA (notify provider of symptoms, prescribed diuretic may control edema, change positions slowly)
CONSTIPATION primarily in Verapamil (high fiber and increased fluids if not contraindicated)
SUPPRESSION OF CARDIAC FUNCTION - BRADYCARDIA and HEART FAILURE (monitor EKG, pulse rate, and rhythm, discontinue med and notify provider if symptoms occur)
DYSRHYTHMIAS widening of QRS and prolonged QT interval
ACUTE TOXICITY resulting in hypotension, bradycardia, AV block, and ventricular tachydysrhythmias (monitor vital and EKG, gastric lavage and cathartic can be indicated, administer appropriate meds, have equipment for cardioversion and cardiac pacer available)
41
Calcium Channel Blockers contraindications/ precautions
pregnancy risk category C, contraindicated with hypotension, heart block, digoxin toxicity, severe heart failure or during lactation, use cautiously in older adults and clients who have kidney or liver disorders, mild to moderate heart failure, or GERD
42
Calcium Channel Blockers nursing administration
do not chew or crush sustained release tablets, administer IV injection slowly over 2-3 minutes, monitor anginal pain and report change in presentation, monitor BP and HR and keep journal of both, do not take med if HR <50 or SBP <90, avoid activities that require alertness, no grapefruit juice
43
Alpha Adrenergic Blockers (Sympatholytics) prototype
Prazosin
44
Alpha Adrenergic Blockers (Sympatholytics) action
selective alpha 1 blockade resulting in venous and arterial dilation, smooth muscle relaxation of the prostatic capsule and bladder neck
45
Alpha Adrenergic Blockers (Sympatholytics) therapeutic use
primary hypertension
46
Alpha Adrenergic Blockers (Sympatholytics) complications
FIRST DOSE ORTHOSTATIC HYPOTENSION (start treatment with low dose, first dose given at night, monitor BP for 2-6 hours, avoid alertness activities for first 12-24 hours, change positions slowly
47
Alpha Adrenergic Blockers (Sympatholytics) contraindications/ precautions
pregnancy risk category C, contraindicated in patients who have hypotension, use cautiously in pts with angina or renal insufficiency and in older adults
48
Alpha Adrenergic Blockers (Sympatholytics) nursing administration
medication can be taken with food, take first dose at bed time, advise of safety measures to avoid orthostatic hypotension/ dizziness
49
Centrally Acting Alpha2 Agonists prototype
Clonidine
50
Centrally Acting Alpha2 Agonists action
Act within CNS to decrease sympathetic outflow resulting in decreased stimulation of the adrenergic receptors (both alpha and beta) of the heart and peripheral vascular system
Decrease sympathetic outflow to the myocardium results in bradycardia and decreased cardiac output (CO)
Decrease in sympathetic outflow to the peripheral vasculature results in vasodilation, which leads to decrease in BP
51
Centrally Acting Alpha2 Agonists therapeutic use
Primary HTN (alone or with a diuretic or another anti-HTN med)
Severe cancer pain (admin parenterally by epidural infusion)
Investigational use: migraine HA ,flushing for menopause, mngt of ADHD and tourette syndrome, mngt of withdrawal symptoms
52
Centrally Acting Alpha2 Agonists complications
```
DROWSINESS and SEDATION
DRY MOUTH (encourage medication compliance, symptom will typically resolve in 2-4 weeks)
REBOUND HYPERTENSION if abruptly discontinued
```
53
Centrally Acting Alpha2 Agonists contraindications/ precautions
Pregnancy risk category C, avoid use during lactation
Avoid use of transdermal patch on affected skin in scleroderma and systemic lupus erythematosus
Contraindicated in clients who have a bleeding disorder or are on anticoagulants
Use cautiously in clients who had a stroke, asthma, COPD, recent MI, DM, major depressive disorder, or CKD
54
Centrally Acting Alpha2 Agonists nursing administration
Administer medication by oral, epidural, and transdermal routes
Medication is usually administered twice a day in divided dose (take larger dose at bedtime to decrease the occurrence of daytime sleepiness)
Transdermal patches are applied every seven days → advise to be placed on hairless, intact skin on torso or upper arm
55
Beta Adrenergic Blockers (Sympatholytics) prototype
Cadioselective Beat 1(affects the heart only)-- Metoprolol
Nonselective Beta 1 & Beta 2 (Affecting both heart and lungs)-- Propranolol
Alpha and Beta blockers-- Labetalol
56
Beta Adrenergic Blockers (Sympatholytics) action
Act directly on the electrical activity in the myocardium of the heart to decrease HR
Decrease myocardial contractility and decrease cardiac output
Decreased rate of conduction through the AV node
Alpha blockade adds vasodilation in medications such as carvedilol and labetalol
Reduces release of renin which decreases angiotensin II and causes vasodilation and promotes excretion of sodium and water
57
Beta Adrenergic Blockers (Sympatholytics) therapeutic use
Primary HTN
Angina, tachydysrhythmias, heart failure, and MI
Suppress reflex tachycardia due to vasodilators
Other uses include tx of hyperthyroidism, migraine HA, pheochromocytoma, glaucoma
58
Beta Adrenergic Blockers (Sympatholytics) complications
Metoprolol and Propranolol: BRADYCARDIA (hold med if HR <50, in patients with DM this med can mask tachycardia which is an early sign of hypoglycemia), DECREASED CO (caution with patients with heart failure, start dose low and titrate to desired level, monitor for worsening heart failure and notify provider with worsening symptoms), AV BLOCK (obtain baseline EKG), ORTHOSTATIC HYPOTENSION (change positions slowly), REBOUND MYOCARDIUM EXCITATION (myocardium becomes sensitized to beta blockers so discontinuation should be over 1-2 weeks)
Propranolol: BRONCHOCONSTRICTION (avoid in clients with asthma, should receive beta1 selective agent if asthmatic patient must be treated), GLYCOGENOLYSIS INHIBITED (challenge of diabetic patient to break down glycogen into glucose)
59
Beta Adrenergic Blockers (Sympatholytics) contraindications/ precautions
Contraindicated in clients who have AV block and sinus brady
Nonselective contraindicated in clients who have asthma, bronchospasm, and heart failure
Use cardioselective cautiously in clients who have asthma
In general use cautiously in clients who have myasthenia gravis, HoTN, PVD, DM, depression, and in older adults as well as those who have a history of severe allergies
60
Beta Adrenergic Blockers (Sympatholytics) nursing administration
Administer medications orally, usually once or twice a day
Atenolol, metoprolol, labetalol, and propranolol can be administered by IV route
Advise clients not to discontinue medication w/o consulting the provider
Advise clients to avoid sudden changes in position to prevent occurence of ortho HoTN
Instruct clients not to crush or chew extended release tablets
Teach clients to self- monitor HR and BP at home on a daily basis
Take with food to increase absorption
61
Medications Used for Hypertensive Crisis prototype
Nitroprusside sodium
62
Medications Used for Hypertensive Crisis action
Direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload)
63
Medications Used for Hypertensive Crisis therapeutic use
Hypertensive crisis
64
Medications Used for Hypertensive Crisis complications
```
EXCESSIVE HYPOTENSION (administer med slowly, monitor BP and EKG continuously, keep client supine during administration)
CYANIDE POISONING/ THIOCYANATE TOXICITY headache and drowsiness, and can lead to cardiac arrest (clients with liver dysfunction are at increased risk, reduced risk by administering for no more than 3 days at rate of 5mcg/kg/min, manifestations include weakness, disorientation, and delirium - Thiosulfate antidote, monitor plasma levels if used for more than 3 days - should be less than 10mg/dL)
BRADYCARDIA, TACHYCARDIA, EKG CHANGES
```
65
Medications Used for Hypertensive Crisis contraindications/ precautions
Pregnancy risk category C
Contraindicated in clients who have heart failure with reduced peripheral vascular resistance, and AV shunt
Use cautiously in clients who have liver and kidney disease, hypothyroidism, hypovolemia, or fluid and electrolyte imbalances, and in older adults
66
Medications Used for Hypertensive Crisis nursing administration
Prepare medication by adding to diluent for IV soln
Note color of soln - may be light brown in color, discard if any other color
Protect IV tubing and container from light
Discard med after 24hr
Monitor VS and EKG continuously
67
Cardiac Glycosides prototype
Digoxin
68
Cardiac Glycosides action
Positive inotropic effect: increased force of myocardial contraction
Increased force and efficiency of myocardial contraction improves the heart’s effectiveness as a pump, improving stroke volume and cardiac output
Negative chronotropic effect: decreased HR
At therapeutic levels, digoxin slows the rate of sinoatrial (SA) node depolarization and the rate of impulses through the conduction system of the heart
A decreased HR gives the ventricles more time to fill with blood coming from the atria, which lead to increased SV and increased CO
69
Cardiac Glycosides therapeutic use
Second line medication
Treatment of heart failure
Dysrhythmias (a-fib)
Can reduce manifestations, but does not prolong life
70
Cardiac Glycosides complications
DYSRHYTHMIAS (caused by interferring with the electrical conduction in the myocardium), CARDIOTOXICITY (leading to bradycardia)
- monitor for signs of digoxin toxicity (normal 0.5-0.8 ng/mL) and hypokalemia (normal 3.5-5.0 mEq/L)
GI effects including ANOREXIA, N/V, ABDOMINAL PAIN
CNS including FATIGUE, WEAKNESS, VISION CHANGES
- vision changes: diplopia, blurred vision, yellow-green or white halos around objects
71
Cardiac Glycosides contraindications/ precautions
Pregnancy risk category C
Contraindicated in clients who have disturbances in ventricular rhythm, including v-fib, v-tach, and 2nd and 3rd degree heart block
Use cautiously in clients who have hypokalemia, partial AV block, advanced heart failure, and impaired kidney function
72
Cardiac Glycosides nursing administration
Advise clients to take the medication as prescribed, if a dose is missed, the next dose should be doubled
Check pulse rate and rhythm before administration and record, notify provider if HR is <60 in adults, <70 in children, and <90 in infants
Administer at the same time every day
Monitor digoxin levels periodically during treatment and maintain therapeutic levels between 0.5 and 0.8 ng/mL to prevent digoxin toxicity
Avoid taking OTC meds to prevent adverse effects and med interactions
Instruct clients to observe for indications of digoxin toxicity (fatigue, weakness, vision changes, GI effects) and notify provider if they occur
If administering IV digoxin, infuse over at least 5 minutes (10- 15 min in clients who have pulmonary edema) and monitor client for dysrhythmias
Management of digoxin toxicity
-Stop digoxin and K-sparing medication immediately
-Monitor K levels, for levels <3.5 administer K IV or PO, do not give any further K if level is >5
-Treat dysrhythmias with phenytoin or lidocaine
-Treat bradycardia with atropine
-For excessive OD, activated charcoal, cholestyramine, or digoxin immune Fab can be used to bind digoxin and prevent absorption
73
Adrenergic Agonists prototype
Catecholamines
- Epinephrine
- Dopamine
- Dobutamine
74
Adrenergic Agonists action
ALPHA 1 RECEPTORS
Activation of receptors in arterioles of skin, viscera and mucous membranes, and veins lead to vasoconstriction
Mydriasis (dilation of pupil)
BETA 1 RECEPTORS
Heart stimulation leads to increased HR, increased myocardial contractility, and increased rate of conduction through the AV node
Activation of receptors in the kidney lead to the release of renin
Epinephrine (in addition to those listed above)
-Increased cardiac output and improved tissue perfusion
Dopamine
-Low and moderate dose
--Renal blood vessel dilation
-High dose
--Renal blood vessel constriction
--Vasoconstriction
Dobutamine
-Increased CO
BETA 2 RECEPTORS
Activation of receptors in the arterioles of the heart, lungs and skeletal muscles leads to vasodilation
Bronchial stimulation leads to bronchodilation
Activation of receptors in the liver cause glycogenolysis
Skeletal muscle receptor activation leads to muscle contraction
DOPAMINE RECEPTORS
Activation of receptors in the kidney cause the renal blood vessels to dilate
75
Adrenergic Agonists therapeutic use
```
Epinephrine (Alpha 1 receptors)
-Slows absorption of local anesthesia
-Manage superficial bleeding
-Decreases congestion of nasal mucosa
-Increased BP
Epinephrine (Beta 1 receptors)
-Treatment of AV block, heart failure, shock, and cardiac arrest
Epinephrine (Beta 2 receptors)
-Asthma
Dopamine (low dose Beta 1)
-Shock, heart failure, AKI
Dopamine (moderate dose Beta 1)
-Shock, heart failure
Dopamine (high dose Beta 1 and Alpha 1)
-Shock and heart failure
Dobutamine
-Heart failure
```
76
Adrenergic Agonists complications
Epinephrine
-Vasoconstriction (HTN crisis due to activation of alpha 1 receptors in the heart)
-Cardiac complications (dysrhythmias due to activation of beta 1 receptors in the heart → activation also increases the workload of the heart and increases O2 demand leading to development of angina)
Dopamine
-Cardiac complications (beta 1 receptor activation in the heart can cause dysrhythmias and also increases the workload of the heart and increases O2 demand, leading to angina)
-Necrosis (can result from extravasation of high doses of dopamine)
Dobutamine
-Increased HR
77
Adrenergic Agonists contraindications/ precautions
Epi and dopamine are pregnancy risk category C, dobutamine is category B
Dopamine is contraindicated in clients who have tachydysrhythmias and v-fib
Use dopamine and dobutamine cautiously in clients who have hyperthyroidism, angina, history of MI, HTN, and DM
Epi should be used cautiously in pts with hyperthyroidism, angina, cardiac dysrhythmias, and HTN
78
Adrenergic Agonists nursing administration
These meds must be administered IV by continuous infusion
Use an IV pump to control infusion
Dosage is titrated based on BP response
Stop the infusion of dopamine at first evidence of infiltration
-Extravasation can be treated with local injection of an alpha- adrenergic blocking agent, such as phentolamine
Assess/ monitor for CP, notify the provider if CP occurs
Monitor urine output frequently for indication of dec kidney perfusion
Monitor EKG continuously, and notify provider of indications of tachycardia or dysrhythmias
Monitor perfusion of extremities
Monitor CO, pulmonary capillary wedge pressure, central venous pressure
79
Organic Nitrates prototype
Nitroglycerin
80
Organic Nitrates action
```
in chronic stable exertional angina, nitroglycerin dilates veins and decreases venous return (preload), which decreases cardiac oxygen demand
in variant (Prinzmetal’s or vasospastic) angina, nitroglycerin prevents or reduces coronary artery spasm, thus increasing oxygen supply
```
81
Organic Nitrates therapeutic use
treatment of acute angina attack
| prophylaxis of chronic stable angina or variant angina
82
Organic Nitrates complications
```
HEADACHE (use aspirin or acetaminophen to relieve pain, notify provider if HA does not resolve in a few weeks- dosage can be reduced)
ORTHOSTATIC HYPOTENSION (avoid sudden change of position)
REFLEX TACHYCARDIA (administer beta blocker such as metoprolol if needed)
TOLERANCE (use lowest dosage needed to achieve desired effect, take long acting forms of nitro with a med free day - reduces risk of tolerance
```
83
Organic Nitrates contraindications/ precautions
pregnancy risk category C
contraindicated in patients who have hypersensitivity to nitrates
contraindicated in clients who have severe anemia, closed-angle glaucoma, and traumatic head injury because the medication can increase intracranial pressure
use cautiously in patients taking antihypertensives and patients who have hyperthyroidism or kidney or liver dysfunction
84
Organic Nitrates nursing administration
pain, BP
85
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) prototype
Atorvastatin
86
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) action
decrease manufacture of LDL and VLDL cholesterol
increase manufacture of HDL
other beneficial effects include promotion of vasodilation, and decrease in plaque site inflammation, thromboembolism, and risk of atrial fibrillation
87
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) therapeutic use
primary hypercholesterolemia
prevention of coronary events (primary and secondary)
protection against myocardial infarction and stroke for clients who have diabetes mellitus
increasing levels of HDL in clients who have primary hypercholesterolemia
primary prevention in clients who have normal LDL
88
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) complications
HEPATOTOXICITY evidenced by increase in aspartate transaminase (AST) (baseline liver function with monitor after 12 wks and 6 months, avoid alcohol)
MYOPATHY evidenced by muscle aches, pain, and tenderness and can progress to myositis or rhabdomyolysis (baseline CK levels and close monitor)
89
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) contraindications/ precautions
pregnancy risk category X
contraindicated in patients who have a liver disorder or are breastfeeding
for Asians, rosuvastatin should be avoided or prescribed in small doses
use caution with patients who have previously had liver disease, acute infections, electrolyte imbalance, or severe metabolic disorders. Dosage of several statins should be reduced for patients who have severe kidney impairment
90
Antilipemic Agents- HMG COA Reductase Inhibitors (statins) nursing administration
lovastatin with evening meal. Other statins can be given without food, but evening is best time to give because cholesterol is synthesized at night
atorvastatin or fluvastatin for kidney impaired patients
baseline cholesterol, kidney and liver function
91
Cholesterol Absorption Inhibitor prototype
Ezetimibe
92
Cholesterol Absorption Inhibitor action
ezetimibe inhibits absorption of cholesterol secreted in the bile and from food
93
Cholesterol Absorption Inhibitor therapeutic use
patients who have modified diets can use this as an adjunct to help lower LDL
can be used alone or in combination with statin med
94
Cholesterol Absorption Inhibitor complications
HEPATITIS (monitor liver function and avoid alcohol use)
| MYOPATHY (monitor CK)
95
Cholesterol Absorption Inhibitor contraindications/ precautions
pregnancy risk category X
contraindicated for patients who have active moderate to severe liver disorders, especially taking statin concurrently
use caution in older adults and other patients who have liver disorders
96
Cholesterol Absorption Inhibitor nursing administration
have client report muscle aches and pain
if CK levels are elevated, may have to DC med
baseline cholesterol, liver and kidney function
low fat, low cholesterol diet, regular exercise
fixed dose combination with simvastatin
97
Bile Acid Sequestrant prototype
Colesevelam HCl
98
Bile Acid Sequestrant action
decrease in LDL cholesterol
99
Bile Acid Sequestrant therapeutic use
may be used alone or as an adjunct with HMG-CoA reductase inhibitor, such as atorvastatin, and with dietary measures to lower cholesterol levels
100
Bile Acid Sequestrant complications
CONSTIPATION
101
Bile Acid Sequestrant contraindications/ precautions
contraindicated in patients who have bowel obstruction or pancreatitis caused by high triglycerides
use cautiously in patients who have biliary disorders and diabetes mellitus, and in older adults
102
Bile Acid Sequestrant nursing administration
colesevelam is taken orally in tablet form. it should be taken with food and 8 oz water and not concurrently with other meds
colestipol is supplies as oral tablet and should not be crushed or chewed. give 30 min before meal
colestipol is also supplied in a powder form. advise patient to use adequate amount of fluid 4-8 oz to dissolve med to prevent irritation or impact esophagus
103
Fibrates prototype
Gemfibrozil
104
Fibrates action
decrease in triglyceride levels (increase in VLDL excretion for clients unable to lower triglyceride levels with lifestyle modification or other antilipemic medications)
increase in HDL levels by promoting production of precursors to HDLs
105
Fibrates therapeutic use
reduction of plasma triglycerides (VLDL)
| increased levels of HDL
106
Fibrates complications
GI DISTRESS
GALLSTONES (RUQ pain)
MYOPATHY- MUSCLE TENDERNESS, PAIN (monitor CK levels)
HEPATOTOXICITY
107
Fibrates contraindications/ precautions
pregnancy risk category C
| contraindicated for patients with liver disorders, severe kidney dysfunction and gallbladder disease
108
Fibrates nursing administration
administer via oral route
| advise patients to take med 30 min prior to breakfast and dinner
109
Anticoagulants prototype
Heparin (Intravenous )
Enoxaparin (Subcutaneous)
Warfarin (Oral)
110
Anticoagulants action
Heparin and Enoxaparin: prevent clotting by activating antithrombin, thus indirectly inactivating both thrombin and factor Xa, inhibiting fibrin formation
Warfarin: oral anticoagulant antagonize vitamin K, thereby preventing the synthesis of four coagulation factors
111
Anticoagulants therapeutic use
Heparin: conditions necessitating prompt anticoagulant activity (evolving stroke, pumonary embolism, massive DVT), adjunct for clients having open heart surgery or renal dialysis, low dose therapy for prophylaxis against postoperative venous thrombosis, treatment of disseminated intravascular coagulation
Low molecular weight Heparin (Enoxaparin): prevent DVT, treat DVT and PE, prevent complications in angina, non- Q wave MI, and ST elevation MI
Warfarin: treatment of venous thrombosis, treatment of thrombus formation in clients who have afib or prosthetic heart valve, prevention of recurrent MI, TIA, PE, and DVT
112
Anticoagulants complications
Heparin: HEMORRHAGE SECONDARY TO OD (protamine antidote, avoid aspirin, PTT 1.5-2 x baseline) THROMBOCYTOPENIA evidenced by low platelet count and increased development of thrombi mediated by antibody development (monitor platelets and stop if below 100,000 - non heparin anticoagulant may be used as substitute) HYPERSENSITIVITY REACTIONS - CHILLS, FEVER, URTICARIA (administer small test dose before full dose) TOXICITY/ OVERDOSE (protamine antidote should be administered slowly no faster than 20 mg/min)
Enoxaparin: HEMORRHAGE, NEURO DAMAGE FROM HEMATOMA formed during spinal or epidural anesthesia, THROMBOCYTOPENIA as evidenced by low platelet count, TOXICITY/ OVERDOSE
Warfarin: HEMORRHAGE (obtain baseline PT and INR, vitamin K is antidote), HEPATITIS, TOXICITY/ OVERDOSE (if vitamin K cannot control bleeding, administer fresh frozen plasma)
113
Anticoagulants contraindications/ precautions
contraindicated in clients who have low platelet count (thrombocytopenia) or uncontrollable bleeding, should not be used during surgery
use cautiously in clients who have hemophelia, increased capillary permeability, dissecting aneurysm, PUD, severe HTN, hepatic or kidney disease, or threatened abortion
Warfarin: pregnancy risk category X, contraindicated in patients with thrombocytopenia or uncontrolled bleeding, contraindicated in surgery, contraindicated in people with vitamin K deficiency, liver disorder, alcohol, or risk of bleeding
114
Anticoagulants nursing administration
Heparin: Assess blood studies, platelet count; monitor PTT daily(should be 1.5-2x control); bleeding, hemorrhage signs: bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, notify prescriber immediately; heparin-induced thrombocytopenia may develop after discontinuation; use soft-bristle toothbrush, avoid contact sports, carry/wear emergency ID, electric razors, avoid OTC meds unless directed
Enoxaparin: monitor antifactor Xa activity in chronic therapy (renal disease), monitor blood studies, assess for bleeding gums, petechiae, ecchymosis, decrease in BP → indicate bleeding & possible hemorrhage (notify provider immediately); assess for neuro sx in patients who received spinal anesthesia/trauma/surgery (spinal hematoma); use soft-bristle toothbrush, avoid contact sports, carry/wear emergency ID, electric razors, avoid OTC meds unless directed
Warfarin: monitor BP, watch for signs of HTN; assess for fever, skin, rash, urticaria; assess for hemorrhage signs like the first two drugs (bleeding gums etc), monitor INR 2-3x week for 1-2 weeks; withhold during menstruation; limit intake of vit k foods (green leafy veggies); use soft-bristle toothbrush, avoid contact sports, carry/wear emergency ID, electric razors, avoid OTC meds unless directed
115
Antiplatelets prototype
Aspirin
| Clopidogrel
116
Antiplatelets action
prevent platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting, inhibit platelet aggregation at the onset of the clotting process, alter bleeding time
117
Antiplatelets therapeutic use
primary prevention of acute MI, prevent reinfarction in clients following an acute MI, prevent ischemic stroke or TIA, acute coronary syndrome, intermittent claudication
118
Antiplatelets complications
Aspirin
GI EFFECTS - N/V DYSPEPSIA (use enteric coated tablets and take with food, concurrent use of proton pump inhibitor may decrease effects) HEMORRHAGIC STROKE, PROLONGED BLEEDING TIME, TINNITUS/ HEARING LOSS
Clopidogrel
BLEEDING and GI EFFECTS - DIARRHEA, DYSPEPSIA, PAIN
119
Antiplatelets contraindications/ precautions
Aspirin
pregnancy risk category D in third trimester, contraindicated in clients with bleeding disorders and thrombocytopenia, use cautiously in clients who have PUD and severe kidney or hepatic disorders, do not give to children or adolescents who have hay fever or recent chicken pox, use with caution in older adults
Clopidogrel
pregnancy risk category B,
contraindicated in clients who have bleeding disorders, thrombocytopenia, PUD, and intracranial bleed
use cautiously in clients with severe kidney or hepatic disorders
clients who are breastfeeding should not take this
120
Antiplatelets nursing administration
Aspirin: Monitor liver function studies, renal function studies, blood studies; check I & O ratio; assess hepatotoxicity: dark urine, clay colored stools, jaundice, itching, abdominal pain, fever, diarrhea; assess for allergic reactions (rash, urticaria); assess for ototoxicity
Clopidogrel: liver function tests, blood studies, assess for sx of MI & stroke, assess for thrombocytic purpura, fever, thrombocytopenia, neurolytic anemia
121
Thrombolytic Agents prototype
Altaplase- often called tPa
122
Thrombolytic Agents action
dissolve clots that have already formed, clots are dissolved by conversion of plasminogen to plasmin, which destroys fibrinogen and other clotting factors
123
Thrombolytic Agents therapeutic use
treat MI, treat massive PE, treat acute ischemic stroke, restore patency to central IV catheters
124
Thrombolytic Agents complications
BLEEDING serious risk of bleeding from different sites - internal bleeding of GI or GU tracts and cerebral bleeding, superficial bleeding - wounds and IV catheter
limit venipunctures and injections, apply pressure to wounds, monitor baseline status, monitor PTT, PT, Hgb, and Hct
125
Thrombolytic Agents contraindications/ precautions
pregnancy risk category C, contraindicated in clients who have potential for bleeding disorders, HTN, or cerebral vascular disorders
126
Thrombolytic Agents nursing administration
monitor VS & neurologic status; temp >104 F indicates internal bleeding; assess for bleeding during 1st hr after a procedure
